Laparoscopic-assisted uterovaginal anastomosis in congenital atresia of uterine cervix: follow-up study.

STUDY

OBJECTIVE

To study the efficacy, safety, and functional outcomes of laparoscopic-assisted uterovaginal anastomosis with placement of a silicone tube as stent in congenital cervical atresia.

DESIGN

Descriptive study (Canadian Task Force classification II-3).

SETTING

Tertiary care referral hospital.

PATIENTS: Fourteen consecutive patients (mean [SD] age, 15.2 [2.0] years) with congenital absence of a uterine cervix, associated with partial or complete vaginal aplasia.

INTERVENTIONS: Laparoscopic-assisted uterovaginal anastomosis with placement of a silicone stent was performed to treat cervical agenesis. In cases with associated vaginal aplasia, modified McIndoe vaginoplasty was performed concomitantly. Follow-up assessment was performed at 1, 3, and 6 months, and then yearly.

MEASUREMENTS AND MAIN

RESULTS

Of 14 patients with congenital cervical anomalies, cervical dysgenesis was observed in 5 (35.7%), and cervical agenesis in 9 (64.2%). All patients with cervical agenesis also had a partial or complete noncanalized vagina. The procedure was successfully completed in all patients. Main outcome measures were functional capability and postoperative complications. Mean (SD) follow-up after surgery was 3.8 (1.2) years. Postoperatively, all but 1 patient (92.8%) experienced regular menses, with complete relief of cyclical abdominal pain. One patient underwent hysterectomy because of genital infection and re-stenosis. Concomitant vaginoplasty was performed in 9 patients (64.2%) with associated vaginal aplasia, and vaginal length was 6.5 (1.2) cm at 6-month follow-up. Five patients (35.7%) are sexually active, and report it to be satisfactory. Pregnancy has been achieved in 3 of the 5 patients (60%).

CONCLUSIONS

Laparoscopic-assisted uterovaginal anastomosis may be considered the treatment of choice in patients with cervical agenesis, and radical treatment such as hysterectomy can be averted. The procedure is successful insofar as resumption of menstrual function. However, long-term reproductive outcome in these young girls will require further follow-up.